Patient information from BMJ
Last published: Dec 01, 2016
Glaucoma (open angle)
If you have glaucoma the main nerve behind your eye is damaged by too much
pressure within the eye. This causes poor eyesight. There's no cure for glaucoma
but there are treatments that can slow down the damage or even stop it completely.
We've brought together the best and most up-to-date research about glaucoma to
see what treatments work. You can use our information to talk to your doctor and
decide which treatments are best for you.
Glaucoma can start suddenly or it can happen over a long time. If your eyes quickly
become painful and red, your vision gets blurred, or you notice halos (rings) around
lights, see a doctor right away. You need urgent treatment.
What is glaucoma?
Your eyeballs are filled with fluid. This fluid is constantly passing in and out of the eyeballs,
bringing nutrients to the eye. But if the fluid doesn't leave the eye as easily as it enters,
pressure can build up inside the eye.
This pressure can press on the nerve at the back of your eye. Over time this can damage
the nerve and affect your eyesight. It's also possible to get glaucoma even when the
pressure in your eyes is normal. This may happen if your nerves are very sensitive to
pressure.
There are several types of glaucoma, including one called angle-closure glaucoma. The
one we deal with here is called open-angle glaucoma, which is the most common.
The main difference between these two types is that open-angle glaucoma tends to
happen gradually, while angle-closure glaucoma tends to come on more suddenly. The
symptoms of the two types of conditions differ, as do the treatments.
Angle-closure glaucoma is a medical emergency.You should always seek urgent medical
attention if you have any sudden changes to your sight.
© BMJ Publishing Group Limited 2016. All rights reserved.
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Glaucoma (open angle)
What are the symptoms?
The first symptoms you may have are small blind spots at the edge of your vision. Without
treatment these spots get slowly bigger until you can only see things directly in front of
you.
Some people with severe glaucoma find it hard to see if they move from a light room to
a darker one. Or they find it difficult to judge the height of steps and curbs. This can
cause trips and falls.
Glaucoma affects your eyesight very gradually. Many people don't notice it at first. You
can get glaucoma in one or both of your eyes. It doesn’t cause pain.
What treatments work?
The aim of treatment for glaucoma is to reduce the pressure in the eye. This can be done
using several types of treatment, including eye drops, laser treatment, and surgery. The
type of treatment your doctor suggests may depend on how severely your sight has been
affected.
Preventing glaucoma
The best thing you can do to protect your sight - whether you have glaucoma or not - is
to have your eyes tested regularly. Some people are more at risk than others of getting
glaucoma. These include:
•
people with a first-degree relative with glaucoma
•
people of African-Caribbean origin, and
•
people with eye problems caused by diabetes.
If any of these apply to you, you should take special care to have regular eye tests.
Eye drops
The first treatment most people are likely to be offered is eye drops.
Some people have medical conditions that mean they can't use eye drops. These people
will usually be offered one of the other available treatments right away.
Eye drops for glaucoma can reduce the pressure inside your eyes and stop your sight
getting worse.
There are several types of eye drops for glaucoma, including some containing drugs
called beta blockers, and others containing drugs called prostaglandin analogues. You
may need to try several types before you find one that works for you. Or you may need
to use two types at the same time.
© BMJ Publishing Group Limited 2016. All rights reserved.
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Glaucoma (open angle)
Eye drops can cause side effects in some people. For example, some people get a
burning or stinging feeling in their eyes. Beta-blockers can cause low blood pressure or
a slow heartbeat. You can help reduce side effects by pressing gently on your tear duct
for a minute or two after you put your drops in. This stops too much of the medicine
getting into your bloodstream. Your tear duct is at the inside corner of each eye, nearest
your nose.
If you get side effects, see your doctor.
Laser treatment
If eye drops don't work well enough, you may need to have laser treatment.
Your doctor numbs your eye with a drop of local anaesthetic, then puts a special lens
against your eye. The laser goes through the lens to the tissue that drains fluid from your
eye, allowing the fluid to drain away more effectively.This can help to reduce the pressure
inside your eye.
Surgery
If other treatments don't work, or if your vision is getting worse rapidly, your doctor may
suggest surgery. An operation to lower the pressure in your eye is called a trabeculectomy.
It takes about an hour. It can be done under local anaesthetic (to numb your eye) or
general anaesthetic (which makes you sleep). You'll probably go home the same day.
Surgery seems to work just as well as laser treatment or eye drops. But it has side effects.
For example, you have an increased risk of cataracts. Cataracts turn your vision cloudy,
but they can be treated with surgery.
It's also possible to get a blind spot in the middle of your vision after surgery for glaucoma.
This is rare, and it is more likely to happen to people with severe glaucoma.
What will happen to me?
Glaucoma is a long-term disease. You'll need treatments and regular check-ups for the
rest of your life. Without treatment, glaucoma would slowly make your eyesight worse.
Over many years, you could even lose your sight. But treatments can help stop the
damage. Most people with glaucoma don't go blind.
The better your eyesight is to start with, the easier it is to protect it. It's also important
that you remember to use your eye drops.
© BMJ Publishing Group Limited 2016. All rights reserved.
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Glaucoma (open angle)
The patient information from BMJ Best Practice from which this leaflet is derived is regularly updated. The most recent
version of Best Practice can be found at bestpractice.bmj.com This information is intended for use by health
professionals. It is not a substitute for medical advice. It is strongly recommended that you independently verify any
interpretation of this material and, if you have a medical problem, see your doctor.
Please see BMJ's full terms of use at: bmj.com/company/legal-information . BMJ does not make any representations,
conditions, warranties or guarantees, whether express or implied, that this material is accurate, complete, up-to-date
or fit for any particular purposes.
© BMJ Publishing Group Ltd 2016. All rights reserved.
© BMJ Publishing Group Limited 2016. All rights reserved.
Last published: Dec 01, 2016
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